Heads Up: Health Care Is Still in Trouble

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While half the country is looking west to see what develops from the latest escalation of the president’s war of words (for the moment) with North Korea, and the other half is looking east, wondering if there will be any proof that the Trump campaign colluded with Russian intelligence in the 2016 election, few seem to be paying attention to the issue that had been dominating public debate at home until just a few weeks ago: healthcare.

The issue of the US health insurance system was taken off the front burner with the evident failure of the Republican effort to repeal and replace the Affordable Care Act. But while it may not be in the headlines as much as it once was, the health care system in the United States is still in need of serious attention.

Insurers, for example, still don’t know whether or not they can expect to continue to receive cost sharing reduction payments from the government, part of the original arrangement made under the law to keep them profitable without raising rates to unaffordable levels.

And while the public may have moved on from President Trump’s suggestion that he would just let the system collapse and then wait for his political opponents to come begging for help, the insurance industry hasn’t.

Just this week, for instance, the health insurer Anthem announced that it would be all but ceasing to offer coverage through the ACA’s health exchanges in the state of Nevada, the latest in a long list of insurers who have had to back away from plans to offer policies on the individual market. And like many of the other insurers taking similar steps, Anthem did so in large part because of the federal government’s failure to create some sort of certainty about the fate of the system.

“While we are pleased that some steps have been taken to address the long term challenges all health plans serving the Individual market are facing, the Individual market remains volatile,” the company said in an explanatory press release. “A stable insurance market is dependent on products that create value for consumers through the broad spreading of risk and a known set of conditions upon which rates can be developed.

“Today, planning and pricing for ACA-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost sharing reduction subsidies and the restoration of taxes on fully insured coverage.”

Nevada Insurance Commissioner Barbara Richardson, in reaction to Anthem’s move, said, “While the [Insurance] Division is disappointed in Anthem’s latest decision regarding its withdrawals, we believed that it was in the interest of the Nevada public to let consumers know about the Anthem decision as soon as possible” declared Commissioner Richardson. “The Division is continuing to work with our state partners on attracting an insurance carrier to serve the 14 bare counties and to support the stability of the market for those insurance carriers who remain.”

As Anthem did, Richardson pointed to uncertainty about the federal government’s plans as a major reason why more than a dozen counties in her state are still seeking even a single insurer to offer coverage to individuals through the exchanges in 2018.

This is not to say that nobody in Congress is aware of the need to fix existing problems with the ACA and provide some kind of assurance of stability as the country heads toward the 2018 open enrollment period.

Speaking to a local television station in his home state of Maine this week, Independent Sen. Angus King said, “I was involved with about one of about a dozen senators from both parties talking about where we go from here and what we can do to improve the Affordable Care Act, to improve the healthcare system, to deal with high premiums high deductibles, and some of those issues. So, you can't be terribly optimistic about what Congress is going to get done, but there's a feeling now of let's get on with it.”

The trouble is that those ready and willing to actually get on with it seem few and far between right now.

On Tuesday and Wednesday, Senate Majority Leader Mitch McConnell and President Trump were still trading barbs about whose fault it was that actual repeal never took place.

McConnell, during a speech in Kentucky, said that the president had placed unrealistic demands on Congress that stemmed from his inexperience. “Our new president has not been in this line of work before, and I think had excessive expectations about how quickly things happen in the Democratic process.”

Trump’s reply, delivered via Twitter on Wednesday, was uncharacteristically tame: “Senator Mitch McConnell said I had ‘excessive expectations,’ but I don't think so. After 7 years of hearing Repeal & Replace, why not done?”

But that came on the heels of his surrogates attacking McConnell much more angrily.

White House social media director Dan Scavino wrote Wednesday, “More excuses. @SenateMajLdr must have needed another 4 years - in addition to the 7 years -- to repeal and replace Obamacare.”

Fox News host Sean Hannity, who has increasingly appeared to play the role of Trump’s unbridled id, wrote, “ No Senator, YOU are a WEAK, SPINELESS leader who does not keep his word and you need to Retire!”

With the debate being conducted at this level, it’s not clear that certainty will be in the offing for anybody in the near future.

A longtime reporter on the intersection of the federal government and the private sector, Rob Garver served as a National Correspondent, based in Washington, D.C., for four years. He has written for ProPublica, The New York Times and other publications.